| NPI | 1699831065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55226) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 5411) |
| 122300000X Dentist (Licence: RI cden03106) | |
| 122300000X Dentist (Licence: NH 03895) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2015-02-25 |